Provider Demographics
NPI:1639395296
Name:PEREZ, FERNANDO (DC)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4176 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2161
Mailing Address - Country:US
Mailing Address - Phone:773-283-3131
Mailing Address - Fax:773-283-3610
Practice Address - Street 1:4176 W MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2161
Practice Address - Country:US
Practice Address - Phone:773-283-3131
Practice Address - Fax:773-283-3610
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor